Wherein a surgeon tells some stories, shares some thoughts, and occasionally shoots off his mouth. Like a surgeon.

Monday, June 23, 2008

ER, Uh...

(Here's post I wrote but didn't publish, a long while ago -- well before a subsequent kerfuffle, or any of my recent rants and the comments thereon... So no, I'm certainly not talking about you. Or you.)

[And the preceding was written longer ago still. I'd figured I'd not publish it at all, because it might be seen in light of some comment-conversations I've had with a particular ER doc. Such is not the case. It was WAY long ago that I wrote it. I suppose the post makes me a hypocrite; except I only rant on weekends, and describe it as such; whereas many ER blogs are suffused with extremities all the time. Plus, I'm about to hang it up, so WTF. Since, increasingly, I can't think of anything new and good, I may as well put the old and bad out there. At one point so long ago, I took the time to write it. So here it is:]

It could be said that the blogs of ER docs are the most colorful of the medblogs (and, by golly, I just did!) With no exceptions that I know of, their proprietors are excellent writers and humorous, plus they have lots of great stories, working as they do with nearly perfect substrate. And it's a pretty good job: never boring, clear and specific (one might say "surgical") tasks, predictable hours, decent pay, no calls when not at work. So why are those guys so pissed off all the time?

Training in one of the nation's premier trauma centers, I think I've seen it all. Inundated every day with countless dispossessed and deprived people whose only source of medical care was the emergency room, we also saw all the trauma and emergency surgical cases transported by every aid car in the city. As an intern just starting out, at first I tried to attach every drunk and druggie to a social worker, the crazies to a shrink, to arrange rehab, make appropriate followup appointments. It didn't take long to realize that in spending that extra time, I was depriving others of needed care. I went from bleeding heart to speeding chart, and got a lot more care to a lot more people. I saw cops and criminals, drunks and dregs, do-gooders, junkies by the bagfull. I've been lied to, spit at, cursed up, dressed down, swung on by people I was trying to help. Some came back and back, promises busted like my nice suture-work. I have no illusions. I understand, and I participated. Dark humor, darker view of humanity: they come with the territory. It's self-preservation, if nothing else. Schadenfreude was I. Joker at expense. Still, I think I managed...

Spending day after day in emergency care takes a heavy toll, I know. I love the stories, I value the work. And yet. Reading some ER blogs -- not all, and by no means all the time -- I find the vitriol off-putting. The derision. And the take-no-prisoners attitude -- the downright hatred, so it often seems -- toward "liberals," suffused throughout. (Not to mention a similar attitude, quite often, toward their own clientele). I love political give-and-take; most of my work-colleagues politicked far to my right, yet we had enlightening and stimulating, good-hearted arguments. But reading some ER blogs, unlike any other category in the healthosphere, is like listening to Rush Limbaugh or Ann Coulter. It's a polemicist's playground. I've had my moments of moral muttering, liberally laced with haughty holiness. I consider George Bush the worst president we've ever had (and no, Mr. Bush, history will not vindicate you). But I've never called him "a bucket of spit." Nor do I kiss off all conservatives as some sort of existential threat. (Some, of course. But not the whole group.) Physicians are, in general, a conservative bunch. But they're also educated; enough, you'd think, to have left their minds at least slightly ajar.

Maybe it's an inevitable corollary: working in an ER turns people. Another possibility: people who lean loudest to the right are the ones who choose the job in the first place. Or perhaps (with a couple of exceptions) it's just that the rightward ER docs blog, and the leftward ones go home and tie-dye.

36 comments:

Some people say political liberalism is motivated by a belief that humanity has the ability to someday get its shit together, while conservatism is motivated by the belief that we will never make it collectively. A busy ER can be pretty convincing evidence of the latter.

As for the blog thing -- isn't that kind of the genera? It's easier to say pithy, witty, negative things than pithy, witty, constructive things.

I think the attitude you ascribe to a smattering of ER doc bloggers can be seen among the populace as a whole.

Intelligence and education is not a benchmark for better behavior - one would hope that merely being a decent person, regardless of social or professional standing, would preclude treating others with such vehemence and derision.

On another note...WHAT? I just stumbled upon your blog two weeks ago and you are hanging it up? Bugger all and /sniffle.

There were a few ER doc/nurse blogs I used to really love reading, for the stories. I don't read them any more now, because I couldn't stomach any more of the attitude toward the poor people, crazy people, and addicted people seen in the ER.

I can't imagine what that job must be like, so I try not to pass judgment. I just know that I don't consider it good reading when half the people in the stories are written about as if they're less than human, and deserving of every misfortune that comes their way.

nicely put. i think you saw on our blog a reference to al gore as a 'warm bucket of spit'. this was not an original quote, rather, a quote from the 32nd vice president, jack garner... "Garner is most noted for saying the vice presidency wasn't worth "a warm bucket of spit," although reporters allegedly changed the spelling of the last word for print.

other than that i heartily agree with you, in the ER one sees the results of every federal give-away and well intentioned responsibility shift.

it's a conservative's hell.

and obtw, jimmy carter and bill cliniton are the worst presidents in your lifetime. in ten years you willa gree with me and maybe ad obama to the list.

911: think where we'd be if reagan hadn't reversed Carter's energy policies. And other than a bj or two, Clinton left us in much better shape, economically, than we are now. I'd give up one for the other; but I'm getting pretty old.

It saddens me to agree; I think those of us in the ED/ER see the best of people and the worst; and more of the latter. And for all my desrie to be a left wing liberal, nothing brings out my inner Nazi like a shift in the ED...Maybe it's just that we spend so much time at work being morally neutral that we have to vent somewhere? Does that make it better? I'm not sure...

As just an everyday person, I've had some interesting reads on the ER blogs. But most times, as I'm about to open one up, I'm wondering to myself "what trainwreck/insult-a-rama will I be reading about now?

It must be hard to work in an ER, and it's not a job I'd be able to do. Still I wonder, does the work attract people who dislike the human race? Or does the work turn everyday people into human-haters?

I haven't seen any ER blogs with all-caps rants shouting "WAKE THE FUCK UP!!!!" and "WHAT THE HELL IS YOUR PROBLEM??? ARE YOU REALLY GONNA BUY THE CRAP THOSE IDIOTS ARE TRYING TO SELL YOU??? #%$$#@@%&?&RS!!!" Have you?

OK, maybe MDOD, but the rest of us are a bit more subtle.

The boiling hatred of many extremist liberals towards President Bush has been unjustified, and he will be ultimately remembered as one of our better presidents after a few years.

Clinton will be known as the BJ president, and Bush will be known as the president who kicked terrorist ass.

Obama will be nothing more than a trivia question after he loses this year.

I guess it's true that all good things come to an end. And I'm NOT talking about the Bush presidency. Can't wait for that to go away! If you really are going to stop posting, please don't take the archives with you. I'll need some withdrawal time, and 2 years of previous posts should just about do it. :-))

the left used to say, 'ask not what your country can do for you, but what you can do for you country'.

now they say, 'ask what your country can do for you, and be really strident about it and when you don't get it blame (insert most dastardly republican name here).'

and a couple of more things.

first, i hold no one in medicine in higher respect than the surgeons. i could not have done a surgical residency. partly this is because of a physical handicap, but that could have been overcome with burning desire. surgical training is necessarily the hardest there is and no one outside of medicine understands this. they can't.

however, in the ER we are at the bottom end of the shit-funnel created by entitlement programs. ER docs really ARE the ones that see and treat all comers. i find it funny that but not surprising that while i am doing this, and while i am giving away, conservatively, $150,000 of free care a year to the lowest socio-economic classes (and that's on top of my taxes), that my rants about being FORCED to do it are perceived by some as 'hateful'.

well, IF they are, i am still the one taking care of the crackheads and criminals along with the sweet little old ladies with MIs. i do it 24/7 and 365 and i challenge anyone to find a single one of my patients that think they got less than the best care possible. i bear no ill will to these folks individually, rather to the folks who think they can't and shouldn't bear some responsibility themselves.

angry? yes. part of the problem? no. hypocritical? no. and this is not directed at you, dr surgeon, i really commented here to make sure the quote about the 'warm bucket of spit' was seen in it's proper historical context...

i have no problem that you think i'm a nut-job or that we ER bloggers seem to be mostly to the right, i DO have a problem with being told how to practice medicine and how to deliver care and who to overbill to pay for those who abuse the system. and i DO have a problem with seing a turd on the ground and trying to figure out which end is the clean one. i also call 'foul' on my fellow ER docs who have ensconced themselves in the middle of good-payor heaven and scold those of us in bumfuck who are asked every year to smile and take a little less and work a little harder and not point out that there is a turd on the ground.

the people telling me this and dictating this are, almost exclusivley, on the left side of the aisle.

for the record, i'm conservative, if obama wanted to seal the border, reduce entitlement programs, make medicine more in line with a market system, and destroy those that want to destroy us then i would vote for him.

sorry you are leaving the blogosphere. hope your career keeps on an upward track. thanks for doing the really hard stuff and sorry that i, or one of my colleagues, is always waking you up with the finally-got-infected-gallbladder-smoker-uninsured-crackhead-pregnant-alcoholic at 4am.

Yes, I am baffled by the number of right wing ER bloggers - nurses, docs, medics, etc. Many of them hail from the south so I guess that is to be expected (so called "red states"). Interesting in that I consider myself more "left of centre" - certainly not "bleeding heart", or socialist, however working in the ER DOES tend to bring you back from the left at times - and it has nothing to do with money ( since most right wingers I know are on the wealthier side and basically voting their pocketbooks). It has to do with getting beaten down with humanity. Seeing people day in and day out abusing our system and driving you nuts makes you angry and disgusted with their behaviour (and all it takes is one lawsuit)- the ripe recipe for becoming a conservative. That said, I am able to separate my anger at INDIVIDUALS from that at society in general and thus feel like I not strayed too far from where I come from. That and the fact that I don't adhere to the Repulicans' blind following of the religious right and their social agenda. Still, it is hard somedays to not leave a patient encounter and say to yourself "Get a damn job!!!". That said, I try to keep my blog more about stories with only a few rants per month(left or right leaning).

Sometimes I wonder how long this who;e blogging thing will last. Part of me thinks it's just a little phase in the evolution of the internet. Sometimes I think it is the future. Other times I think blogs, and blogging communities, comes in waves or flocks, like birds migrating around the web. They ebb and flow, come and go. But as long as Google is still there, one's blog lives on long after the last post.

It's not just the ED guys. The surgeon bloggers I've seen (Aggravated DocSurg comes to mind) are equally conservative. There are just a lot more ED guys because they tend to be a) younger and b) have more free time to blog.

Honestly, in light of where you trained and lived you're probably the exception. It's no coincidence that the people who have to deal with the seediest parts of humanity (and this definitely includes general surgeons) tend to be conservative. The fact is that there are a lot of lazy SOBs with a sense of entitlement and a lawyer on speed dial on Medicaid. For some people this colors their political views, for others it doesn't.

Maybe because I'm still young and green, but I'm none of those things. I'm not bitter, I'm not angry, and when someone is pissing me off it's far more likely to be a rude colleague (read: surgeon) than a patient.

And I'm not right-wing. I like to consider myself a champagne-sipping socialist. ;-) No, seriously, I'm Liberal all the way. Actually, I'm more NDP/Green Party for those familiar with the Canadian system.

@scalpel: A HRC golden retriever and an Edwards Hitler are anything but subtle. You're not kidding anyone portraying yourself as someone trying to remain above the fray.

@911doc: Left side of the aisle? It's only been a Democrat-controlled congress for what, 2 years now? What's your explanation for the last 12 years prior to that? Unless you want to concede that GOP lawmakers were hopelessly impotent to prevent what you see as wasteful entitlements when they had the majority, you might want to reconsider blaming everything on the left.

Sid, there's too much to comment on, so I'll post on my own blog in a bit. Anyone's free to cross-comment there.

Huh. I'd have taken a different conclusion. The obvious inference is that conservatives could be expected to be open-minded but for some reasons ER docs aren't. But to see that in what I wrote takes, uh, education and open-mindedness, I guess.

enrico, i'm speaking in generalities. EMTALA was passed during the heyday of tip o'neil running the congress. i admit that i do not know who wrote the law, and the idea behind it is nice enough on first blush... the idea being that sick folks can not be turned away from a hospital based on an inability to pay, but the idea of making a law out of it without funding, that's liberal. unfunded mandate. that's liberal. the idea that 'the government' can regulate, by law and by setting up bureaus and committees how medical care is delivered and to whom and how much it will cost, is past liberal and is, in fact, communist. i'm not exagerrating. EMTALA takes from those who have and gives to those that don't. it is directly responsible for the current crisis in care. it made things a lot worse for a whole bunch of patients but the result is not talked about because the intent was warm and fuzzy. that's liberalism in a nutshell. intentions not results. emotions over logic. peace

Any "liberal" blogger who suggests a doctor or nurse who is conservative is uncaring or "vitriolic" because we aren't terribly pleased with the rampant abuse we see daily in the system, including the physical and verbal abuse, is using a form of manipulation. Nothing more, nothing less. It's rather rare to find either a doctor or nurse who doesn't "care". Some may be fed up with something, but we still "care".

If you ever see a someone comment that a doctor or nurse is "uncaring" or some variation thereof, whether it be from a patient who is displeased with the wait time for their cough or from a liberal surgeon to an ER doctor because they rant on system abusers, it's almost always a manipulation tactic.

Uncaring and vitriolic aren't the same thing at all. The former is not what I was talking about. I said in the BLOGS of ER DOCS it seemed there were far more conservatives than liberals, and that they were vitriolic in their WRITING. I speculated about it. Show me where it isn't true. I wasn't commenting on their care at all. In fact, I said I valued the work. It's an interesting phenomenon, and a subject of curiosity.

I find the vitriol off-putting. The derision. And the take-no-prisoners attitude -- the downright hatred, so it often seems -- toward "liberals," suffused throughout. (Not to mention a similar attitude, quite often, toward their own clientele.

Vitriol (bitter hatred) combined with the terms "derision" and [general, I guess] "hatred" towards patients pretty much sells me on the idea that you're implying the unnamed ER docs to whom you refer are not caring towards their patients. It's hard to make the case that "caring" and vitriol, derision, and hatred go together. He's caring, yet vitriolic, derisive and hateful towards his clientele and liberals alike. Um. What?

Okay, fine, take away what you will. It's, after all, exactly the problem we have politically: people assuming things and preventing themselves from actually hearing. It should be obvious even to you that I have no knowledge whatever of the care rendered by the bloggers. I only know what they write, and it's about the writing that I wrote. If you can't see the obviousness of that, well, I rest my case. And if you don't see derision in some of the words, well, I rest my head. The only people who can leap from specific words to imagined meaning or those who -- need I say it? -- have manipulation in mind. I wrote about writing. You read whatever you want; and, no doubt, indeed you will.

Well, the liberal mantra is to label conservatives "uncaring" towards the poor and needy. This is just sorta saying that without really using that word.

Oh, and if a patient behaves badly to a physician or a nurse or abuses the system with no real legitimate reason to do so, they deserve to be called out. Everyone has a responsibility to be reasonably polite (or at least non-threatening) and to not rob the nation's health care system because they think they're entitled to do so, especially if their care is 100% paid for by other people.

I think 911Doc sums up the understandable frustration that ER personnel feel. It makes sense to me that, when all you ever see is a bunch of poor people trying to get medical care from a system not designed to handle their routine health-care needs, plus assorted trauma and overdose cases, and pretty much get shit on all the time by everybody you see, you'd get damn cynical damn quick.

And I guess it would be hard not to blame the faces you see rather than the faces you don't.

We liberals blame the health-care system, not the people, for the non-emergency-care burdens and unfair funding of non-profit hospitals' ERs. Easy for me to say, though, as I sit in my nice house with my nice family and prepare for bed.

Still, anyone who thinks W will be judged kindly by history is a mental case. Denial ain't just a river in Egypt.

About Me

Boring, Unoriginal, but Important Disclaimer:

What I say here is as true as I can make it, based on my experience as a surgeon. Still, in no way is it intended as specific medical advice for any condition. For that, you need to consult your own doctors, who actually know you. I hope you'll find things of interest and amusement here; maybe useful information. But please, please, PLEASE understand: this blog ought not be used in any way to provide the reader with ideas about diagnosis or treatment of any symptoms or disease. Also, as you'd expect, when I describe patients, I've changed many personal details: age, sex, occupation -- enough to make them into no one you might actually know. Thanks, and enjoy the blog.